How best to deal with endocarditis.

Infective endocarditis (IE) is an infection of the endocardial surface, usually involving heart valves and/or prosthetic intracardiac devices. Although much emphasis has been placed on antimicrobial prophylaxis prior to dental work to prevent IE, the evidence supporting this approach and its effectiveness are lacking. Resulting in valvular dysfunction, continuous bacteremia with constitutional features, embolic phenomena, and immune-mediated disease, diagnosis of IE requires careful history taking, physical examination, and utilization of echocardiography, blood work, and microbiologic tests. IE is uniformly fatal without effective therapy. Treatment for most cases requires prolonged courses of bactericidal antimicrobials in doses sufficient to penetrate vegetations and kill the microorganisms. Drug-resistant organisms, prosthetic intracardiac devices, comorbid illness, and valvular dysfunction often complicate therapy, necessitating a look towards adjunctive cardiac surgery. Better data (in the form of population-based surveillance and clinical trials) is beginning to impact the management of infective endocarditis.